Effect of preoperative extracorporeal membrane oxygenation therapy on post-ventricular assist device outcomes in critically ill pediatric patients-an analysis of the STS Pedimacs Database

The article written by Peer et al. [1] deals with a very fascinating topic that is gaining interest in recent publications. The key question is ‘How does preoperative ECMO support impact survival after VAD implantation in critically ill paediatric patients?’. Whether a preoperative ECMO affects VAD outcomes has been analyzed in adults [2, 3], but few data are available in pediatrics [4]. The authors presented the results of a retrospective study using data from the PEDIMACS registry. The outcome of patients with INTERMACS 1 and 2 profiles was analyzed with particular attention to the effect of pre-VAD ECMO. Among the 541 patients enrolled in the registry, 391 received a primary VAD (P-VAD group) and 150 received the VAD after ECMO support (E-VAD group). P-VAD and E-VAD groups were different: patients in the E-VAD group were younger and more critically ill than patients in the P-VAD group. In fact, the distribution as INTERMACS profile was very different among P-VAD and E-VAD (P-VAD profile 1: 25%, profile 2: 75%/E-VAD profile 1: 67%, profile 2: 33%). In addition, they had higher rate of previous cardiac operations and congenital heart disease and the percentages of patients intubated and fed through a nasogastric tube were higher compared to the P-VAD group.